Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

Diagnostic

CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.

Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.

Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.

A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.

An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.

Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.

Disposition

I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won't make it back.

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.

Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the "lockdown", our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.

Treatment

Supportive

worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.

Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.

We are also using Azithromycin, but are intermittently running out of IV.

Do not give these patient's standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.

Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.

Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.

The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn't often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.

Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis.

We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.

One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.

I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all.

The Trump administration, state officials and even individual hospital workers are now racing against each other to get the necessary masks, gloves and other safety equipment to fight coronavirus — a scramble that hospitals and doctors say has come too late and left them at risk. But according to a previously unrevealed White House playbook, the government should’ve begun a federal-wide effort to procure that personal protective equipment at least two months ago.

The strategies are among hundreds of tactics and key policy decisions laid out in a 69-page National Security Council playbook on fighting pandemics. Other recommendations include that the government move swiftly to fully detect potential outbreaks, secure supplemental funding and consider invoking the Defense Production Act — all steps in which the Trump administration lagged behind the timeline laid out in the playbook.

“Each section of this playbook includes specific questions that should be asked and decisions that should be made at multiple levels” within the national security apparatus, the playbook urges, repeatedly advising officials to question the numbers on viral spread, ensure appropriate diagnostic capacity and check on the U.S. stockpile of emergency resources.

The playbook also stresses the significant responsibility facing the White House to contain risks of potential pandemics, a stark contrast with the Trump administration’s delays in deploying an all-of-government response and President Donald Trump's recent signals that he might roll back public health recommendations.

“The U.S. government will use all powers at its disposal to prevent, slow or mitigate the spread of an emerging infectious disease threat,” according to the playbook’s built-in “assumptions” about fighting future threats. “The American public will look to the U.S. government for action when multi-state or other significant events occur.”

The guide further calls for a “unified message” on the federal response, in order to best manage the American public's questions and concerns. “Early coordination of risk communications through a single federal spokesperson is critical,” the playbook urges. However, the U.S. response to coronavirus has featured a rotating cast of spokespeople and conflicting messages; Trump already is discussing loosening government recommendations on coronavirus in order to “open” the economy by Easter, despite the objections of public health advisers.

The NSC devised the guide — officially called the Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents, but known colloquially as “the pandemic playbook” — across 2016. The project was driven by career civil servants as well as political appointees, aware that global leaders had initially fumbled their response to the 2014-2015 spread of Ebola and wanting to be sure that the next response to an epidemic was better handled.

STFU froggy fuck. Trump and the administration has done more than any other... look in the god damn mirror you POS... you will be begging Trump for help before this is over because America was rated #1 by the WHO and NIT in preparedness while your country was so far down it was not rated... less than some third world countries... You are doing nothing but snooty french waiter bullshit.

Trump complimented travel restrictions before intelligence and health officials even thought about it, then he was demonized by them.

Milo, you're a pile of shit. This thread is just some information about the virus. I posted it because it might help some of us. The first thing you do is make it political..... and you have no fucking business talking about our politics. Mind your own business up there in that fuck hole you live in

British scientist Neil Ferguson ignited the world’s drastic response to the novel Wuhan coronavirus when he published the bombshell report predicting 2.2 million Americans and more than half a million Brits would be killed. After both the U.S. and U.K. governments effectively shut down their citizens and economies, Ferguson is walking back his doomsday scenarios.

Ferguson’s report from Imperial College, which White House and other officials took seriously, said that if the U.S. and U.K. did not shut down for 18 months, and isolation measures were not taken, “we would expect a peak in mortality (daily deaths) to occur after approximately 3 months.” His “models” showed overflowing hospitals and ICU beds.

“For an uncontrolled epidemic, we predict critical care bed capacity would be exceeded as early as the second week in April, with an eventual peak in ICU or critical care bed demand that is over 30 times greater than the maximum supply in both countries,” the report reads.

Dr. Deborah Birx, the White House coronavirus response coordinator, reportedly said the administration was particularly focused on the Imperial College report’s conclusion that entire households should stay in isolation for 14 days if any member suffered from COVID-19 symptoms.

But after tens of thousands of restaurants, bars, and businesses closed, Ferguson is now retracting his modeling, saying he feels “reasonably confident” our health care system can cope when the predicted peak of the epidemic arrives in a few weeks.

Testifying before the U.K.’s parliamentary select committee on science and technology on Wednesday, Ferguson said he now predicts U.K. deaths from the disease will not exceed 20,000, and could be much lower.

British scientist Neil Ferguson ignited the world’s drastic response to the novel Wuhan coronavirus when he published the bombshell report predicting 2.2 million Americans and more than half a million Brits would be killed. After both the U.S. and U.K. governments effectively shut down their citizens and economies, Ferguson is walking back his doomsday scenarios.

Ferguson’s report from Imperial College, which White House and other officials took seriously, said that if the U.S. and U.K. did not shut down for 18 months, and isolation measures were not taken, “we would expect a peak in mortality (daily deaths) to occur after approximately 3 months.” His “models” showed overflowing hospitals and ICU beds.

“For an uncontrolled epidemic, we predict critical care bed capacity would be exceeded as early as the second week in April, with an eventual peak in ICU or critical care bed demand that is over 30 times greater than the maximum supply in both countries,” the report reads.

Dr. Deborah Birx, the White House coronavirus response coordinator, reportedly said the administration was particularly focused on the Imperial College report’s conclusion that entire households should stay in isolation for 14 days if any member suffered from COVID-19 symptoms.

But after tens of thousands of restaurants, bars, and businesses closed, Ferguson is now retracting his modeling, saying he feels “reasonably confident” our health care system can cope when the predicted peak of the epidemic arrives in a few weeks.

Testifying before the U.K.’s parliamentary select committee on science and technology on Wednesday, Ferguson said he now predicts U.K. deaths from the disease will not exceed 20,000, and could be much lower.

I am soooo fucking sick of the doom and gloom fuckwads walking back their predictions because... because... they were full of shit in the first place and did not take into account.. well... did not take into account anything...

OOOOOOOH THE WORLD WOULD HAVE ENDED BUT... SOMETHING HAPPENED TO STOP IT!!!!

no fucking shit? Take your graphs and shove em up your ass.. better yet? use em to light a candle for the people you gave fatal panic attacks to. Go fuck yourself.

Playwright Arthur Miller once told a story about a geologist who remarked that life was possible even in the vast American desert. All you needed was water, he said, and the largest reservoir on the globe was located right under the Rockies.

But how would he get it?

Simple -- drop a couple of atomic bombs.

But what about the fallout?

"Oh," said the geologist, "that's not my field."

Today, the epidemiologists are prepared to nuke the entire American economy to kill a virus.

What about the jobs, the suicides, the heart attacks, the lost careers, the destruction of America’s wealth?

Oh, that's not my field.

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If politicians only got paid according to their district's economic success, there would be no more Democrats.

I am so sick of the excuses tho for why they world did not end. No.. . we are not under 20' of water or burning up with MMGW... . no.. millions did not die in America.. whatever.. some new crybaby shit every month it seems these days.